June 24, 2007

At one of the country's most esteemed cancer centers, where great phycisians combat the rarest diseases, Dr. Monica Bertagnolli takes the cases no one else can.

Colleagues say her surgical skills save patients who have few places to turn to rid their bodies of stubborn and deadly cancers. And her prowess in the lab has influenced the drugs that tens of thousands take to prevent colon cancer.

"I would consider her one of our superstars," said Dr. Michael Zinner, chief of surgery at Brigham and Women's Hospital.

The Dana-Farber Brigham and Women's Cancer Center plans to announce this week that Bertagnolli, 48, is the new surgical oncology chief.

She's the first woman to hold that job - an impressive feat given that so few women are surgeons. Nationally, about 85 percent of surgeons are men.

She also leads a vital research lab at Brigham and Women's, where she collaborates with up to 20 colleagues on preventing colon cancer, which kills 50,000 Americans a year.

Bertagnolli, a Princeton-educated mother of two who grew up on a Wyoming cattle ranch, accepts her prestige and responsibility with a rare and endearing humility.

"You're lucky like I am if you have lots of people to help you," Bertagnolli told the Herald last week during a series of interviews about her work, including rare access to the operating room.

She said she loves caring for patients while attacking the "puzzle of biology" in the lab. "There's no greater thrill than figuring out something new," she said.

She is quick to point out that there haven't been that many surgical oncology chiefs at the cancer center, and that she couldn't do her job without a team of oncologists, researchers and nurses.

While this is true, few people could do what she does, her colleagues do not hesitate to say.

A football-sized tumor

Four years ago, Bertagnolli removed a football-sized tumor from Steve McAllister's stomach and a tennis ball-sized one in his leg. The deadly masses were connected by a long cancerous tentacle.

McAllister, a 53-year-old school superintendent, drives annually from Danville, Iowa, to Boston for checkups with Bertagnolli. After four years and no cancer recurrence, she's cutting him loose. Wednesday was their last visit.

"It's your graduation day," she told him, hugging him goodbye.

Bertagnolli is a virtuoso at treating soft-tissue sarcoma, the type of cancer that McAllister had.

It is a cancer of the body's connective tissue - muscles, blood vessels, fat - and has many varieties. Soft-tissue sarcoma makes up 1 percent of all cancer cases.

Removing these tumors can be treacherous because they wrap around vital organs and embed themselves in blood vessels.

That is where Bertagnolli is asked to lend her skills.

She is often asked to take care of patients whose tumors other surgeons haven't cleared, or patients that others have refused to operate on, colleagues said. Another one of her specialties is the treatment of tumors from a little-heard-of gastrointestinal disease that has genetic links to colon cancer.

"It's what I love doing," she said. "I love doing too many things, which is why I'm so busy."

Bertagnolli said her work is guided by three basic outcomes of cancer treatment. The first two result in some improvment in a patient's life.

"The third is, No matter what we do the disease just wins," she said. "The third category is unacceptable. We can't let that happen."

Dr. Jeff Thurlow, director of surgical services at York Hospital in York, Maine, who once worked with Bertagnolli, said a risky tumor removal that Bertagnolli performed on one of his patients several years ago saved the man's life.

"She did some radical surgery on him," he said. "Without that level of expertise, that young fellow would have never survived."

Dr. Suzanne George, clincial director of the Center for Sarcoma and Bone Oncology at Dana-Farber, said Bertagnolli takes the most complex of cases.

"Things that it's clear that it's best they be in her hands," said George, an oncologist.

Two growing boys

As Bertagnolli pulls her electric blue convertible into the driveway of her Newton home after seeing patients all day, her oldest son, Ben, 10, who is autistic, is lightly spraying their black standard poodle, Lily, with a garden hose. The dog is soaked.

Her son, David, 8, rides a scooter and the nanny tells Bertagnolli he's been to the dentist.

"I have three cavities," he said.

"Three cavities!" she exclaimed, shifting comfortably into her other avocation - mom.

Bertagnolli, the daughter of first-generation French and Italian immigrants still living in Wyoming, spends any free time with her family. She also longs to learn Italian.

Her husband, Alex Dannenberg, 46, who pulled up minutes before his wife on this particular evening, said he understands that he married a woman blessed with hands that can save people's lives.

"She's physically gifted in a way that few people are," he said.

She has such a deep and personal connection with her patients, he said, that it "whittles her down quite a bit."

"She deals with horrendous, tough things and uplifting things everyday," he said. "She has not encased herself in a shell to prevent it from affecting her."

Bertagnolli would never consider herself superhuman, even if her patients see her as a godsend in dark times. To this humble doctor, it's all about keeping an even keel.

`'You can't do a good job at work, if you don't have balance at home," she said. "It's important to have balance."

Job: Recently appointed chief of surgical oncology at Brigham and Women's Hospital and Dana-Farber Cancer Institute.

Family: Married, two boys, Ben, 10, and David, 8.

Education: Princeton; University of Utah College of Medicine.

Hobbies: Cooking, spending time with her family, horseback riding.

Sidebar: SURGEON, RESEARCHER, SUPERDOCTOR

Dr. Monica Bertagnolli, chief of surgical oncology at Dana- Farber Brigham and Women's Cancer Center, is a surgeon and researcher, whihc leaves her little free time but lets her see the science in her lab at work in the operating room.

"Not many people try and live in both worlds, but that is the only way we are going to do better with this disease. Scientists can provide great insights, but they are not going to help solve the problem of cancer unless someone can bring it to the patient," she said.

Here's what she does.

LAB WORK: Identify markers of early intestinal cancers and try to manipulate them to prevent tumors or treat existing cancers. Her main focus is the study of a gene that causes Familial Adenomatous Polyposis, an incurable gastrointestinal disease. The same gene defect also causes colon cancer.

CLINICAL TRIALS: Lead investigator on a multi-million dollar trial on the painkiller Celebrex, which prevents some kinds of colon cancer but carries heart risks for some patients, the study found.

SURGERY: Focus is the removal soft-tissue sarcoma, a rare cancer of the body's connective tissues; also removal of tumors associated with Familial Adenomatous Polyposis and general cancer surgery.